ACL recovery and rehab. 1 year Diary.
Below are the diary entries I made while documenting my recovery and return to skiing after my ACL operation 1 year ago. Immediately after the accident I struggled to find accurate information on the likely time line for the rehab, and when I could expect to be skiing once I'd had the ACL reconstruction.
Hopefully this will help those in a similar situation.
I owe huge thanks
to my surgeon, Mr Crichlow
and the staff at the Princess Royal Hospital, Telford and The Nuffield in Shrewsbury. My operation was via the NHS and the whole process was quick and the outcome as good as I could have wished for. Thanks also to Mr Moreau
for his help on the initial consultation.
Huge thanks also to my physio's, Philip Newton
and Sue MacLauchlan
from Lilleshall Sports Injury Rehab
with who's help I was able return to skiing quicker than would otherwise have been the case. They did a fantastic job and I'd recommend them to any one returning to sport after an ACL reconstruction.
The accident was on the 21st March 2012 in Serre Chevalier, skiing off piste in a gully.
The French doctor confirmed a suspected ACL after an X-Ray and some hands on checking. The insurance company insisted I returned home with on my scheduled flight.
UPDATE: 25th March
After some deliberation I decided to drop in to A&E on the Saturday evening I landed back in the UK. After a chat to the triage nurse who consulted with the on duty doctor, they sent be away but not before booking into the fracture clinic on Monday morning. At this point it looks like a good call and has saved a few days over seeing a GP.
I've been busy with the small exercises suggested by my private physio and all feels pretty good, and the rage of movement seems encouraging. For reference I've also taken a note of my current thigh diameter and my weight.
Much laughter from the nurse when she spotted the bill from the French pharmacy.
UPDATE: 26th March
I attended the fracture clinic at the local NHS hospital this morning. It really could not have gone better. The consultant checked the knee and made positive comments regarding the stability. I also managed to score an MRI as someone had cancelled that morning.
The knee specialist is in later this week and they are both going to check the scans and decide on the treatment from there. He did suggest that depending on the scans that the knee surgeon may be keen to do it sooner rather than later, perhaps in the next couple of weeks.
I've had the 'OK' to try and work the leg, so will try and keep the muscle tone. Surprising how much has gone already.
Fingers crossed on the MRI results now.
UPDATE - Day of ACL reconstruction operation, 4th May 2012
I'm back at home now lying on the sofa with a bag of peas on my knee, having gone into surgery at about 11am. When I woke up I think
it was 1.30ish. Initially there was not much discomfort but as the afternoon has wore on it's become more painful, along with increasing swelling and reducing mobility. Extension seems good, it's the flex. Still everyone seems pleased with the way it had gone and my questions about the rehab and tell me they expect a good outcome Fingers crossed !!
Interestingly the pain is at the 'harvest' sites rather than the knee. (I had the hamstring ACL op.)
UPDATE: Week 1, post op.
In the end I had a straight ACL reconstruction, and the surgeon reported no damage to the meniscus etc. The first day was pretty uncomfortable, mostly due to the amount of swelling. It's hard to move your leg with what must have been a 1/2 litre of fluid transforming it into a football !
However, a week in the swelling is much reduced and muscle tone is visible when I tense my quads. I'm happily walking up stairs on the 'bad' leg and have ditched crutches except for first thing in the morning. I'm able to walk 50m or so to garden pond and back again, but I'm not sure of I would like to do much more than that for now. According to the physio's protractor I've 95^ of flex. She also 'suggested' not to be using the bad leg on the stairs - at least if we are going to follow the surgeons rehab protocol.
My approach in the 1st week has been -
Ice (Frozen Pea's, asda 2kg packs seem best) 20 mins per hour.
Leg elevated on the sofa & on pillows at night.
Using my trips up the stairs as an opportunity to try and lift\flex the bad leg (after day 3 or 4).
I've kept off my feet as much as possible, and focused on trying to keep the blood moving (Ankle flexing\pumping) and getting\keeping full extension, so Quad tensing while trying to flatten leg. In terms of regaining flex, I've tended to build it into everyday activities, using gravity to help it flex getting out of bed in the early days, and thinking about how my feet are positioned when sitting down so that I can gently increase the flex.
I've just chased the follow up appointment with the surgeon as it hadn't come through and that's scheduled for Wednesday afternoon.
Other than that the next objective is to get to the shops to stock on on Ibuprofen and Paracetamol as my prescription is about to run out. The buying restrictions are going to be a pain !!
Overall so far so good and each day has seen improvement.
2 Week Update:
2 weeks in and all would seem to be going OK. Swelling is much reduced and most evident above the knee when standing. I'm mostly off the paracetamol except for a couple before bed, but am continuing with the ibuprofen in the hope it will help with the last of the swelling. The actual prescription pills ran out after about a week. Still uncomfortable at night (although not painful) so tending to wake up early morning. The actual joint feels pretty good, twinges tend to be from the soft tissue around it and the hamstring area.
In terms of activity, I'm happy to walk up \ down stairs and have not used the crutch in a few days. Walking is OK, but I've probably not managed more than about 500 meters in one go. My gait feels a but odd, slightly stiff and heavy. Walking the dog yesterday evening became painful although that was after a more active day so I headed home a lot sooner than I planned. However I did make it to the pub later on. Proprioception seems OK, probably as a result of the work I did pre-op.
Flex is improving and I can fold myself into my car. Driving is fine and have practiced a couple of emergency stops to be absolutely sure. The op notes were quite clear in specifying 2 weeks.
My lower leg \ shin is pretty sore and has some numbness on the skin and is hot to touch and colors up red. I had my 2 week follow up with the surgeon on Wednesday and he was very happy with my progress and thought the lower leg would improve with time. Next follow up in a month.
I'm weaning myself off the regular 20 mins of ice per hour and trying to get more active now the swelling is reduced. Muscle loss is visible on the operated thigh so I'm keen to get working to address that. Next NHS physio is on Wednesday and I'm planning to have a session with my private physio for a second view.
All in all very different to the first few days. My next 'real life' target is to build up to walking a reasonable distance with the dog around the village.
Update - 5 weeks
Two weeks on and the knee feels 'lighter' allowing a more normal gait and is now comfortable at night. It's sore at times, sometimes at side, sometimes to front when under load and in hamstring area in recent days although I've now stopped the pain killers. I saw my NHS physio on Wednesday who was happy for me to move on to the next page of drills and OK'd walking. She didn't have a view as to an appropriate amount so I'm building back up and doing maybe 30 mins with a view to working up to an hour.
Interestingly the new exercises seem to include more rapid ballistic(?) leg movements (Flicks & Catches) plus 'light' jogging which is bit daunting. I think I'll be building up on those carefully but having tried a little it's not so bad. I guess the problem is it's easy to get into a slow mode of movement which becomes habituated.
The follow up NHS treatment is odd. My physio didn't recognise some of the exercises noted on the rehab sheet so we googled them on the day. She's never received a copy of the surgery notes or rehab protocol except the copies I acquired. The surgeon asked me back in 4 weeks but no appointment has come through as yet so I'll be chasing them on Monday. It's not a problem for me, but if you were the type to let things slide I'm not sure the outcome would be as good as it could.
Update - 6 weeks.
Jogging isn't going so well ! I went to the NHS physio yesterday and suggested that jogging was tricky and she looked surprised and suggested that it's not in the protocol.
After pointing it out to her she shrugged muttered about impact & flat ground and we never really decided on how to resolve it.
The crux is I'm suffering some pain to the front of the kneecap. Again she's not worried about it but walking in town at lunchtime it was a little sore, which is unusual. I'm hoping it will settle down as different types of discomfort come and go.
I'll probably book up with my sports physio week after next and see what she has to say. Last time she was focused on reducing the swelling but I still have some. Next Friday is the 8 week point and the next page on the Rehab protocol, which includes such delights as hopping, Running, 'Cutting'?. Plyometrics(?) and Ballistics?
The good news is I'm regaining muscle bulk and at the present rate should be back to pre injury size in just a few weeks. (edit - ha ha ha !)
UPDATE - Week 8
The knee & leg feels noticeably stronger week by week, although on odd days it feels like I've taken a backwards step.
I'm comfortably walking up to an hour at a time although when standing a lot at the weekends the knee can become heavy with increased swelling. I'm still icing a couple of times a day when I remember along with stretches and mobilising the kneecap.
I'm still getting some discomfort at the front of the knee when under load but it's possible to work through it. The physio today thinks it will improve as I rebuild muscle. I'm tending to do less specific 'rehab' exercises at the weekend, choosing more 'real world' standing, walking & gardening.
I'm just back from the PFA Rehab centre at Lilleshall and my physo there is happy with the progress - at least she didn't tell me off this time ! Last time she was concerned with the swelling and the amount of walking I was doing. The plan for the next few weeks is more of the same rehab protocol exercises but building more reps for each exercise, and more often.
My confidence in an earlier post about rebuilding muscle bulk seems a little misplaced as there has been no change in the last 2 weeks, but I hope to change that with more reps and work this week. It's been suggested that I join the footy players in their rehab sessions at some point in the next few weeks and I may even join a gym.
As long as I don't have to move to quickly the leg feels not much different than before, and I seem to have as much 'active' flex as the good leg - however I can't yet sit on my heals. However it would be a different story if I had to run, hop, jump or make sudden movements on it.
Still not allowed any walking in the hills but I think 2 or 3 weeks should see me there. I'm toying with some simple climbing (avoiding the 'bad' leg) at the week 12 stage just to get some upper body exercise. I'm confident I can protect it now, but we'll see how it feels.
UPDATE - Week 12
Half way there (ish) and the last 4 weeks have been a nice step forward.
Surprisingly (and disappointingly) my NHS physio has pretty much discharged me while on the other hand I've started a 'strength' program with my 'broken footballers' sports physio. These exercises hurt (!), the worse being standing from a chair on 1 leg but after a week or so the exercises are easier and I've gained a little muscle bulk on the bad leg. I'm trying to keep to one drill every 30 minutes. The new exercises can make the knee feel heavy and sore but generally the swelling is mostly constant and isn't too aggravated by exercise. I'm still icing when I remember, generally after walking.
I had the OK to walk our local hill as long as I didn't 'yomp' it. It's 250m vertical over about 1.2 miles on a rough road\track and makes for an excellent place to train. Stupidly I forgot my sticks for the walk down, but even without them and going slowly it felt ok, and an improvement on the first time back on the hill a few days before. I'll try and do this a couple of times a week, time allowing.
The second highlight was getting back on my motorbike. It's a small super sports 250 which means that you have to ride it to get the best from it. I still don't quite have enough flexion to move around as freely as I need but it was nice to get out and the leg felt better than it did pre op.
Both physio's have spoken positively about skiing at the 6 - 7 month mark with puts me in the frame for a early season week in Tignes. I think a trip to Manchester before hand, say September time should be cool.
I'm not running, hopping, skipping or climbing yet but I'd say that the knee is now better that it was immediately pre op. I guess it's now a case of diminishing returns, but easy skiing again in the next few months feels a realistic goal.
The real trick I think will be to manage my return to rock climbing.
Update - Week 17
Since the last update it's been a case of 'steady as you go'.
At the 14 weeks I had another appointment with the 'broken footballers' physio where they measured the relative strength between the legs. The good news was the hamstrings were within a few percent, however the quads were about 35% down. Another set of rehab drills resulted focused on addressing that. All in all the physio seemed pleased and thought that it was about normal.
August being holiday season means that rehab exercises haven't always been front of mind but my hols did give a chance to do some more walking and indulge in a little 'rock hopping' at the coast. One thing that became apparent is that my calf isn't as strong as it was but over all I'm getting some confidence back in the knee.
Highlights have included a 5 mile coastal path walk, more motorbikes and return to indoor gentle indoor climbing. I'm walking my local 'hill' a couple of times a week and as of last week I'm about 10% down on the time I would have expected before the accident, although that was the first attempt at a time.
The knee\shin area is sore although it doesn't seem related to specific activities. Arguably at it's worse when on holiday! That said it feels that I'm working it quite hard with the drills and walking and at the end of each day I can feel it. There's little noticeable swelling, and again that doesn't seem to be affected by activity but I am still icing from time to time.
The only real 'iffy' moment during the last few weeks was a sideways feeling from the knee while on an uneven beach but there was no discomfort and it seems to have held together. Climbing was a difficult as it is very hard to know what's appropriate, so caution is the order of the day.
I still need a bit more flex as highlighted by the last ride on the bike. Although it was improved since last time I couldn't move around as much as I'd need to be fast.
The next few weeks should be interesting. I've an appointment with the surgeon, the possibility of a ski at a 'dome and another strength test and physio session - all within a week of each other. Fingers crossed.
Update. Week 20.
This seem a good time to post an update. Since the the last one a few I've seen the surgeon, received yet another set of physio drills and did I mention that I went skiing
I went Skiing at Manchester, I'm climbing a bit harder, I have a pleased surgeon who said 'do stuff, but not too much all at once' and last night I posted a fast time up my local training hill. I'm only getting minor, 'puffy' swelling if any.
The not quite so good:
It's still sore at times & hanging around in a fridge for 6 hours doesn't help. I'm still a weakling when it comes to quad strength.
The important points are probably the skiing and strength. Skiing at 20 weeks post op will not be for everyone. I ski to a high standard (Coach & Instructor) but was very careful. As it happens my first session was shadowing an Instructor refresher course which meant that I was able to recap from straight running, through ploughing to easy parallel. That very easy progression worked very well and seems a good, safe way to get back to it. Skiing later in the day the knee felt strong with no twinges or issues. My main focus was to avoid being wiped out by some errant slope user.
With successful skiing under my belt I was looking forward to seeing my physio to hear his view on how things are going. He put me on the strength testing machine and the results were 'interesting' ! While my hamstrings are now stronger than my 'good' leg, but my Quads have only reduced their deficiency from 35% to 30%
However the physio seems to think that if I put the work in we can get that down to 10% and skiing in the Alps is still a reasonable goal for early December. However it goes to show that despite it all feeling 'OK' in a dome and at home there is still a big deficiency to be corrected.
In the mean time it's going to be a case of more strength work on the quads with a progression towards more dynamic stuff (running \ jumping etc.) I've a pass to ski on our plastic slope but physio's main concern is the risk of collision. I'm allowed to climb harder which should also help with all round strength.
Next stop the Alps, fingers crossed.
Update - Week 25:
Just back from the physio. The strength machine reports that both legs are now roughly the same, with the hamstrings a bit stronger than the quads. The 'good' leg is a bit weaker than on the original test and as quads are usually stronger than the Hamstrings I'll need to continue the strength work for a few weeks yet. The good news is that since the last visit (about 5 weeks ago) I've managed a 35% improvement in strength on the 'bad' leg. The new physio regime now includes a lot of agility drills plus a continuation with the strength work so it's not over yet.
From a practical point of view I'm comfortable skiing on plastic but teaching beginner snowboarding was a bit uncomfortable. Last weekend was spent yomping around Snowdon including some scrambling and that was fine. Still can't sit completely in my heals
If you are Midlands based I'd recommend the Sports Injury Rehab guys at Lilleshall ( http://www.lilleshall.com ) who have a lot of experiance fixing PFA footballers coming back from ACL ops. Better still thay are about to move into their swanky new building that's going up there. The cost is £35 per session and I'm doing a session every 5 weeks or so which keeps it affordable. In return I'm given a list of drills to do at home and an assessment of where I am in the recovery.
UPDATE - 7 months.
So the moment of truth came last week in Tignes on the PSB. I originally booked expecting some nice sunshine and easy piste skiing on the Glacier. Instead it snowed constantly except for the sole sunny day on Thursday. Despite promising the physio to take it easy with no off piste & no bumps it was impossible to resist. Actually given the number of people on piste I reckon the off piste was probably safer wink
To compensate I tended not to ski much after Lunch and the knee held up very well. By then there was generally some mild soreness but it's hard to say if some of that wasn't psychological. I tended to feel more tired than usual but presumably I've lost some of my usually fitness over the Summer. I was always conscious that this was the first week back and backed out of stuff I'd usually have gone for.
By day five I was probably back to skiing 80% of normal but scored a couple of epic powder lines and some good speed on piste. Fingers crossed I'll regain the rest over the next couple of trips. Mostly it's a question of confidence. snowHead
Update - Month 8.
Just back from my second full weeks skiing and all went OK. Fast on piste, steep off piste, soft bumps and some powder. I skied mostly all day and while the whole thing wasn't discomfort free, it was fine while actually skiing and the bad one didn't hurt any more than the good one !
I also had a day on a snowboard. Rubbish hire kit aside it was all good. My main concern was riding the lifts as the operated knee is my leading leg. Having a few kgs of board swinging around didn't seem too appealing but in the end it felt fine. With hindsight I'm not sure I've heard of knee damage for boarders while on lifts.
The next step for me will be a return to technical training and\or GS race training. In my mind I don't feel quite ready for that right now but I'd think that would be reasonable by the end of the season.
I injured the knee on a off piste week last March and at the time thought it would be doubtful that I'd be there this year. As it happens I'd have no hesitation booking up and skiing the same lines again.
Update - Month 10.
My Surgeon discharged me today after the final check up. He suggested continuing to build strength in the 'bad' leg until it's as strong as the old one and told me not to damage it again !
I was going to book into the physio one last time in the Spring so I'll be sure to do this and get them to measure the respective strength of both legs on their fancy machine. I suspect there will be nothing in it despite the difference in bulk between them but that they both would benefit from some more work.
1 year update (or there abouts).
Just back from a run out on the motorbike which is probably the final 'test' for the repaired knee. Pre Winter I lacked enough flex to be able to properly place my foot on the footrest and moving around on the bike was hard, partly due to the lack of flex but also due to lack of strength. It's a 250 super sports bike so requires a certain amount of input to get the best from it.
Todays short ride was perfect. As much (or more) flex as the 'good' leg, no probs moving around on the bike and I'd be confident to get back on track and chase lap times.
The last couple of days the knee has been pretty sore down the out side of the knee while walking, but I've been back to working it at the behest of my physio. Hopefully a case of no pain, no gain....